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Magnusson P.,Linköping University | Magnusson P.,Linkping University Hospital | Davie M.W.J.,Robert Jones and Agnes Hunt Orthopaedic and District Hospital | Sharp C.A.,Linkping University Hospital | Sharp C.A.,Robert Jones and Agnes Hunt Orthopaedic and District Hospital
Scandinavian Journal of Clinical and Laboratory Investigation | Year: 2010

Background: Alkaline phosphatase (ALP) is routinely used in the assessment of Paget's disease of bone (PDB); however, the individual bone ALP isoforms (B/I, B1, and B2) have not been investigated in this disorder. methods: Subjects comprised 37 patients (mean age 74 years) with symptomatic PDB confirmed by radiograph and stratified into high and low total ALP activity groups and 66 healthy individuals (mean age 64 years). Extracts of human cancellous and cortical bone tissues were also investigated. The bone ALP isoforms, measured by HPLC, were compared with two bone ALP immunoassays (Metra® and Ostase®), and the bone formation marker intact amino-terminal procollagen type I propeptide (iPINP). Results: All bone ALP isoforms were increased in high ALP activity PDB compared with the low ALP activity and control groups (p < 0.0001). The B2 isoform had the greater relative activity representing 36%, 50%, and 71%, of the total ALP activity in the control, low and high ALP activity groups, respectively. Compared with controls, B2 was increased in the low ALP activity PDB group (p < 0.05). ROC analysis showed a validity of approximately 80% for B2 to discriminate patients with PDB. Conclusion. All bone ALP isoforms were increased in patients with high ALP activity PDB and the B2 isoform was even elevated in the low ALP activity PDB group. The bone ALP isoform B2 may be of use in the management of PDB but that has to be further elucidated in subsequent studies. © 2010 Informa UK Ltd.

Samuelsson U.,Linkping University Hospital | Carlsson A.,Lund University | Ivarsson S.,Skåne University Hospital | Kockum I.,Karolinska Institutet | And 3 more authors.
Diabetes/Metabolism Research and Reviews | Year: 2013

Background: There are seasonal variations and gender differences in incidence of type 1 diabetes (T1D), metabolic control and responses to immune interventions at onset of the disease. We hypothesized that there are seasonal and gender differences in residual insulin secretion already at diagnosis of T1D. Methods: In 2005, a national study, the Better Diabetes Diagnosis, was started to classify all newly diagnosed children and adolescents with diabetes. About 95% (3824/4017) of the patients were classified as T1D, and our analyses are based on the patients with T1D. Results: C-peptide was lower in younger children, 0-10years of age (0.23±0.20nmol/L) than in older children, 11-18years of age (0.34±0.28nmol/L) (p<0.000 ). There was a seasonal variation in non-fasting serum C-peptide, significantly correlated to the seasonal variation of diagnosis (p<0.01). Most children were diagnosed in January, February and March as well as in October when C-peptide was highest, whereas fewer patients were diagnosed in April and May when serum C-peptide was significantly lower (p<0.01). The seasonal variation of C-peptide was more pronounced in boys than in girls (p<0.000 and p<0.01, respectively). Girls had higher C-peptide than boys (p<0.05), especially in early puberty. Conclusions: Both seasonal and gender differences in residual beta cell function exist already at diagnosis of T1D. These observations have consequences for treatment and for randomizing patients in immune intervention clinical trials. © 2012 John Wiley & Sons, Ltd.

Sandborg M.,Linköping University | Sandborg M.,Linkping University Hospital | Rossitti S.,Linköping University | Pettersson H.,Linkping University Hospital
European Radiology | Year: 2010

Abstract Purpose: To assess patient skin and eye lens doses in interventional neuroradiology and to assess both stochastic and deterministic radiation risks. Methods: Kerma- area product (PKA) was recorded and skin doses measured using thermoluminescence dosimeters. Estimated dose at interventional reference point (IRP) was compared with measured absorbed doses. Results: The average and maximum fluoroscopy times were 32 and 189 min for coiling and 40 and 144 min for embolisation. The average and maximum P KA for coiling were 121 and 436 Gy cm2, respectively, and 189 and 677 Gy cm2 for embolisation. The average and maximum values of the measured maximum absorbed skin doses were 0.72 and 3.0 Sv, respectively, for coiling and 0.79 and 2.1 Sv for embolisation. Two out of the 52 patients received skin doses in excess of 2 Sv. The average and maximum doses to the eye lens (left eye) were 51 and 515 mSv (coiling) and 71 and 289 mSv (embolisation). Conclusion: The ratio between the measured dose and the dose at the IRP was 0.44±0.18 mSv/ mGy indicating that the dose displayed by the x-ray unit overestimates the maximum skin dose but is still a valuable indication of the dose. The risk of inducing skin erythema and lens cataract during our hospital procedures is therefore small. © European Society of Radiology 2009.

Nilsson A.,Sahlgrenska University Hospital | Wiig M.,Uppsala University Hospital | Alnehill H.,Örebro University | Berggren M.,Linkping University Hospital | And 4 more authors.
Acta Orthopaedica | Year: 2010

Background and purpose The Artelon CMC spacer is designed for surgical treatment of osteoarthritis (OA) in the carpometacarpal joint of the thumb (CMC-I). Good results using this degradable device were previously presented in a pilot study. We now present results from a larger randomized, controlled, multicenter study. Patients and methods 109 patients (94 females) with a mean age of 60 (4283) years, suffering from painful CMC OA, were included in the study at 7 centers in Sweden. The patients were randomized to Artelon CMC spacer (test, n=72) or tendon arthroplasty (control, n=37) at a ratio of 2:1. Perceived pain was recorded on a visual analog scale (VAS) before treatment and after 3, 6, and 12 months, when measuring maximal tripod pinch strength (primary outcome measure). In addition, range of motion, radiographic findings, and functional testing were recorded pre- and postoperatively. Results Swelling and pain were more common in the test group and 6 implants were removed because of such symptoms. 5 of these patients did not receive antibiotics preoperatively according to the study protocol. In a per-protocol analysis, i.e. patients without signs of concomitant OA in the scaphoid-trapezium-trapezoid (STT) joint and those in the test group who received antibiotics, the mean difference in tripod pinch strength increase, adjusted for baseline, was 1.4 kg in favor of the test group (not statistically significant). Statistically significant pain relief was achieved in both groups, with perceived pain gradually decreasing during the follow-up period. In the intention-to-treat analysis but not in the per-protocol analysis, significantly better pain relief (VAS) was obtained in the control group. Patient-perceived disability evaluated by the DASH questionnaire improved in both groups. Interpretation The Artelon CMC spacer did not show superior results compared to tendon interposition arthroplasty. Proper use of preoperative antibiotics and a thorough patient selection appear to be important for the results.

Westerberg J.,Vrinnevi Hospital | Harder H.,Linkping University Hospital | Magnuson B.,Linkping University Hospital | Westerberg L.,Skvde University | Hyden D.,Linkping University Hospital
Journal of Laryngology and Otology | Year: 2011

Objective: To present the results of primary myringoplasty procedures together with the perforation cause, perforation size and site, surgeon's experience, and surgical method, and to investigate how these factors relate to graft take rates.Study design: Retrospective chart review of 243 consecutive patients undergoing primary myringoplasty with temporalis fascia underlay over a 10-year period from 1994 to 2004.Results: The overall graft take rate was 95 per cent. The retroauricular approach resulted in a 97 per cent graft take rate, whereas a significantly lower rate (77 per cent) was seen for surgery conducted via the endaural approach, or via an ear speculum. There was no relationship between other factors and tympanic membrane healing.Conclusion: No association was found between perforation cause and graft take rate. The underlay technique is safe and reliable, and the retroauricular approach is preferable as it enables good surgical access and has better results. Copyright © 2010 JLO (1984) Limited.

Zdolsek J.M.,Linkping University Hospital | Morrison W.A.,OBrien Institute | Morrison W.A.,University of Melbourne | Dingle A.M.,OBrien Institute | And 5 more authors.
Journal of Vascular Surgery | Year: 2011

Objectives Dense angiogenic sprouting occurs from arteriovenous loops (AVLs) incorporating autologous vein grafts inserted into empty plastic chambers in vivo. The purpose of this study was to determine if angiogenesis from the AVL was limited by substituting an "off the shelf" cold-stored allograft vein instead of an autologous vein. Methods Four Sprague Dawley rat groups (two AVL configurations × two chamber types) were established for both 2-week and 6-week harvest. Control AVLs were autologous femoral vein grafts harvested from the left femoral vein that were surgically inserted between the cut femoral artery and vein on the right side. Experimental " allograft" AVLs were rat femoral veins cold-stored (4°C, sterile) for 4 to 7 weeks and then microsurgically interposed between the right femoral artery and vein of an unrelated rat. The two AVL types were inserted in one of two plastic chamber types smooth or perforated. At harvest, the AVL constructs were checked for patency, weighed, their volume determined, and histology undertaken. Morphometric assessment of percent and absolute volume of major tissue components (including blood vessels) at 6 weeks was completed. Results There were no significant differences between autograft and allograft groups in construct weight, volume, or morphology at 2 or 6 weeks. No statistical differences occurred in the percent or absolute vascular volume of AVLs incorporating a cold-stored allograft vs autologous vein grafts at 6 weeks regardless of the chamber type. However, perforated chambers caused significant increases in construct weight (P = .015), volume (P = .006), and percent and absolute connective tissue volume at 6 weeks (P = .001) compared to smooth chamber constructs, regardless of the graft type. Conclusion Cold-stored small-caliber allografts interposed in AVLs do not inhibit microcirculatory development and can be used in composite tissue engineering. © 2011 Society for Vascular Surgery.

Perez M.R.,World Health Organization | Applegate K.E.,Emory University | Rehani M.M.,International Atomic Energy Agency | Ringertz H.G.,Linkping University Hospital | George R.,International Society of Radiographers and Radiological Technologists
Journal of the American College of Radiology | Year: 2011

Quality imaging may be described as "a timely access to and delivery of integrated and appropriate procedures, in a safe and responsive practice, and a prompt delivery of an accurately interpreted report by capable personnel in an efficient, effective, and sustainable manner." For this article, radiation safety is considered as one of the key quality elements. The stakeholders are the drivers of quality imaging. These include those that directly provide or use imaging procedures and others indirectly supporting the system. Imaging is indispensable in health care, and its use has greatly expanded worldwide. Globalization, consumer sophistication, communication and technological advances, corporatization, rationalization, service outsourcing, teleradiology, workflow modularization, and commoditization are reshaping practice. This article defines the emerging issues; an earlier article in the May 2011 issue described possible improvement actions. The issues that could threaten the quality use of imaging for all countries include workforce shortage; increased utilization, population radiation exposure, and cost; practice changes; and efficiency drive and budget constraints. In response to these issues, a range of quality improvement measures, strategies, and actions are used to maximize the benefits and minimize the risks. The 3 measures are procedure justification, optimization of image quality and radiation protection, and error prevention. The development and successful implementation of such improvement actions require leadership, collaboration, and the active participation of all stakeholders to achieve the best outcomes that we all advocate. © 2011 American College of Radiology.

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